Provider Demographics
NPI:1548533854
Name:BURRELL, ADANNA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ADANNA
Middle Name:
Last Name:BURRELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E ARAPAHO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2499
Mailing Address - Country:US
Mailing Address - Phone:214-432-6535
Mailing Address - Fax:972-544-6390
Practice Address - Street 1:1212 E ARAPAHO RD STE 200
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2499
Practice Address - Country:US
Practice Address - Phone:214-432-6535
Practice Address - Fax:972-544-6390
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10055600Medicaid